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Healthcare Claims Processor

Job Description


GENERAL PURPOSE: The Claims Specialist serves Medicare, Medicaid and commercial insurance customers by determining insurance coverage; examining and resolving Medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Responsible for processing healthcare claims in accordance with production, timeliness and quality standards.
  • Participates with other health plan departments in the resolution of claims issues across department lines.
  • Ensures claims are processed in compliance with governmental and accrediting agency regulations.
  • Ensures the delivery of superior customer services by providing timely and accurate claims payment and responding timely to member and provider inquiries and complaints regarding claims processing.
  • Develops strong intradepartmental relationships with other department personnel and/or exempt individual contributors to ensure clear communication and prompt resolution to issues.
  • Follows departmental policies and procedures regarding claims adjudication.
  • Ensures that potential fraudulent claims practices are identified and reported to the appropriate compliance department.
  • Follows all HIPAA compliance guidelines to ensure protection of member protected health information.
  • Performs other duties as assigned.


QUALIFICATIONS AND REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED) required; minimum two years experience in managed care claims processing environment required; experience with the internal configuration of claim processing systems and the links between contracts, utilization management and claims processing within these systems required; or an equivalent combination of education, training and experience.

Job Requirements

 

Job Snapshot

Location US-FL-Tampa
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Accounting, Admin - Clerical, General Business
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Company Overview

Staffing Now

STAFFING NOW® is one of the fastest growing administrative recruitment services in the country. We specialize in matching administrative professionals with the right temporary or full-time job opportunities in a variety of clients in all industries. Staffing Now can help you build your career! SNI Companies®, the parent company of Staffing Now specializes in the placement of Accounting & Finance and IT candidates on a temporary and full-time basis through its Accounting Now and SNI Technology. Learn More

Contact Information

US-FL-Tampa
Staffing Now
Snapshot
Staffing Now
Company:
US-FL-Tampa
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Accounting, Admin - Clerical, General Business
Store Type:

Job Description


GENERAL PURPOSE: The Claims Specialist serves Medicare, Medicaid and commercial insurance customers by determining insurance coverage; examining and resolving Medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Responsible for processing healthcare claims in accordance with production, timeliness and quality standards.
  • Participates with other health plan departments in the resolution of claims issues across department lines.
  • Ensures claims are processed in compliance with governmental and accrediting agency regulations.
  • Ensures the delivery of superior customer services by providing timely and accurate claims payment and responding timely to member and provider inquiries and complaints regarding claims processing.
  • Develops strong intradepartmental relationships with other department personnel and/or exempt individual contributors to ensure clear communication and prompt resolution to issues.
  • Follows departmental policies and procedures regarding claims adjudication.
  • Ensures that potential fraudulent claims practices are identified and reported to the appropriate compliance department.
  • Follows all HIPAA compliance guidelines to ensure protection of member protected health information.
  • Performs other duties as assigned.


QUALIFICATIONS AND REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED) required; minimum two years experience in managed care claims processing environment required; experience with the internal configuration of claim processing systems and the links between contracts, utilization management and claims processing within these systems required; or an equivalent combination of education, training and experience.

Job Requirements

 
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Healthcare Claims Processor Apply now